阳明病。脉迟。食难用饱。饱则微烦。头眩。必小便难。欲作谷疸。虽下之。腹满如故。所以然者。脉迟故也。
脉迟。中寒也。食难用饱。饱则微烦者。胃寒不化。强饱则满闷而烦也。头眩者。谷不腐化而浊气郁蒸也。
必小便难者。寒邪在里。下焦无火。气化不行也。食既不化。小便又难。则水谷壅滞。所以欲作谷疸。谓之欲作。盖将
作未作之时也。
谷疸者。寒在中焦。胃不能化。脾不能运。谷食壅滞。中满发黄也。通评虚实论云。黄胆暴痛。五脏不平。
六腑闭塞之所生也。此虽下之。腹满如故。不为少减者。皆以脉迟而寒邪在里。所以寒下无效也。
阴阳应象论云。寒气生浊。热气生清。又云。浊气在上。则生 胀。若不温中散寒。徒下无益也。
阳明病。若中寒不能食。小便不利。手足 然汗出。此欲作固瘕。必大便初硬后溏。所以然者。以胃中冷。
水谷不别故也。
若字不必作如字解。若中寒不能食者。言阳明若为寒邪所中而不能食者。即前不能食者为中寒之义也。
小便不利者。寒邪在里。三焦之气化不行也。 然汗出。邪入阳明之本证也。手足 然汗出。则又不同矣。
阳明脉解云。四肢者。诸阳之本也。灵枢终始篇云。阳受气于四末。太阴阳明论云。四肢皆禀气于胃。如下
文阳明脉迟。有潮热而手足 然汗出者。为大便已硬。此胃气实而手足 然汗出也。此所谓手足 然汗出者。
以寒邪在胃。欲作固瘕。致四肢不能禀气于胃。阳气不达于四肢。卫气不固。故手足亦 然而冷汗出也。
寒邪固结。中气不行。所以欲作固瘕。固瘕者。寒聚腹坚。虽非石瘕肠覃。月令所谓水泽腹坚之意也。初硬
后溏者。胃未中寒之时。中州温暖。尚能坚实。自中寒之后。胃寒无火化之功。三焦无气化之用。水谷不分。
胃气不得坚实而溏也。故又申明其旨曰。所以然者。以胃中冷。水谷不别故也。
辨误 注家以前人坚固积聚为谬。而曰大便初硬后溏。因成瘕泄。瘕泄。即溏泄也。久而不止。则为固
瘕。愚以固瘕二字推之。其为坚凝固结之寒积可知。岂可但以溏泄久而不止为解。况初硬后溏。乃欲作固瘕
之征。非谓已作固
瘕。然后初硬后溏也。观欲作二字。及必字之义。皆逆料之词。未可竟以为然也。
阳明病。初欲食。小便反不利。大便自调。其人骨节疼。翕然如有热状。奄然发狂。 然汗出而解者。
此水不胜。谷气与汗共并。脉紧则愈。
初者。阳明本经受病之初也。欲食。非能食也。仲景原云能食为中风。不能食为中寒。曰初欲食者。
谓阳明受病之初。寒邪在经。尚未深入。胃气犹在。故欲食也。胃无邪热。小盒饭利。今小便不利。故曰反也。
寒邪固闭。三焦不运。气化不行。故小便反不利也。若阳明热邪归里。大盒饭硬。今反自调。尤知无里热也。
骨节疼者。在经之寒邪未解也。翕翕如有热状。寒气衰而阳欲复也。奄然发狂。郁伏之阳迅发。汗欲出而烦
躁如狂也。翕然有热。奄然发狂。则阳回气润。阳蒸阴而为汗。故 然汗出而寒邪得解也。水不胜。谷气与汗俱并。
未详其义。或曰水者。津液也。谷气者。胃气也。水不胜者。津液不足以作汗也。脉紧则愈者。在太阳则紧
为寒邪在表。在阳明则紧为里气充实。脉浮为邪气在经。紧则浮去而里气充实也。原其所以然之故。皆由寒邪
郁滞。无阳气以蒸腾。则津液不得外达而为汗。故曰水不胜也。胃阳之谷气。既不能蒸津液而为汗。故谷气与汗
共并而不得发泄也。素问评热论云。人之所以汗出者。皆生于谷。谷生于精。今邪气交争于骨肉而得汗者。是邪
却而精胜也。精胜则当能食而不复热。复热者。邪气也。汗者。精气也。以此推之。则人身之汗。皆生于胃中
之谷气。精者。津液之谓也。谷生于精者。言津液乃谷气所化也。谷气者。胃中之阳气也。阳气胜。则能蒸
津液而为汗。故为邪却而精胜。若寒邪胜。阳气不能蒸津液而为汗。故谓之水不胜也。（谷气说见太阳
上编火劫第四条）
阳明病。不能食。攻其热必哕。所以然者。胃中虚冷故也。以其人本虚。故攻其热必哕。
不能食。阳明中寒也。攻其热者。以寒药治之也。哕。呃逆也。其所以然者。盖以阳明中寒。胃中虚冷故也。
以其人平素胃气本属虚寒。而粗工浅智。妄拟为热。而以寒下之药攻之。致苦寒伤胃。令胃阳败绝而成呃逆
难治之证也。
若胃中虚冷不能食者。饮水则哕。
言胃中虚冷而不能食者。胃脘之阳大衰。非但以寒攻热而致哕也。即以冷水饮之。则哕矣。
脉浮而迟。表热里寒。下利清谷。四逆汤主之。
此与少阴厥阴里寒外热同义。若风脉浮而表热。则浮脉必数。今表虽热而脉迟。则知阴寒在里。阴盛格阳
于外而表热也。虚阳在外。故脉浮。阴寒在里。故脉迟。所以下利清谷。此为真寒假热。故以四逆汤祛除寒气。
恢复真阳也。若以为表邪而汗之。则殆矣。
阳明病。反无汗而小便利。二三日呕而咳。手足厥者。必苦头痛。若不咳不呕。手足不厥者。头不痛。
阳明本经受病。固当自汗出。即从太阳转入阳明者。亦当 然汗出矣。此以无汗。故曰反也。其所以无汗者。
寒在阳明之经也。小便利者。里无热邪也。二三日呕而咳。则知无汗在二三日之前矣。二三日前。即称阳明病。
尤知其为阳明本经自入之邪。非太阳传经之邪矣。然邪由营卫而入。必假道于太阳而入。所以无汗也。一日无
汗而小便利。至二三日呕咳手足厥者。寒邪入里也。呕者。寒邪深入而犯胃也。咳者。有声无痰之称。阴盛迫阳于上。
肺气上逆而咳也。四肢为诸阳之本。太阴阳明论云。四肢皆禀气于胃。寒邪入胃。则阳气不充于四肢。致阴阳
不相顺接而厥也。呕
咳而厥。则阴邪纵肆。格阳于上。故虚火上浮而必苦头痛也。若不呕不咳不厥。则无阴盛格阳之病。故头
亦不痛也。
辨误 此条与阳明中风之但头眩不恶寒。故能食而咳。其人必咽痛。若不咳者咽不痛之条。一寒一热。
恰相对待。盖示人以辨证之法也。奈何注家以为无汗呕咳。手足厥者。得之寒因而邪热深也。不知厥阴条
内之厥者必热。前热者后必厥。因是阴阳相半之经。故有厥深热亦深。厥微热亦微之论。所以又云反发其汗者。
必有口伤烂赤之患。此条虽属阳明。实阳明中寒之证。并无热邪在里。岂可亦作此论。且又云若不咳不呕
不厥而小便利者。邪热必顺水道而出。窃恐既有邪热在里。小便未必顺利。即使能利。邪热亦未必肯从小便而出。
若曰不从汗少。偏从水道而出。吾不信也。成氏以伤寒寒邪内攻立论。方氏以寒胜为解。当亦不甚相远也。
阳明病。法多汗。反无汗。其身如虫行皮中状者。此以久虚故也。
邪在阳明。于法当多自汗。今反无汗。而身如虫行皮中状者。皆由寒邪郁于肌腠之间。不得发泄故也。此无
他。不过因元气素虚。无阳气以鼓泄其阴液以为汗。使邪气欲出而不得之所致也。
食谷欲呕者。属阳明也。吴茱萸汤主之。得汤反剧者。属上焦也。
此所以辨太阳阳明之疑似也。食谷欲呕。似乎阳明中寒之不能食。故曰属阳明也。胃寒不纳。故以吴茱萸汤
温胃。若得汤反剧者。非胃寒也。仍是太阳之表邪在胸而呕。犹未入胃。故为属上焦也。娄氏谓得汤反剧者。
火也。当用生姜黄连治之。其意因得热反剧。故以苦寒为治。而加生姜止呕。不知仍是太阳呕逆。尚属表邪。仲景
虽未立方。若发热无汗。尚未发表。外邪将次入胃而呕者。邪犹在胸。当以栀子豉汤涌之。庶几近似。
吴茱萸汤方
吴茱萸（一升洗） 人参（三两） 生姜（六两） 大枣（十二枚）
上四味。以水七升。煮取二升。去滓。温服七合。日三服。
吴茱萸一升。当是一合。即今之二勺半。人参三两。当是一两。即宋之二钱七分。生姜六两。当是二两。
即宋之五钱余。大枣当是四五枚。水七升。亦当是三升。观小承气汤止用水四升。调胃承气只用水三升。
此方以辛热补剂。而用之于表里疑似之间。岂反过之。大约出之后人之手。非仲景本来升合分两。学人当因
时酌用。铢两升合法见卷首。
阳明病。脉迟。虽汗出不恶寒者。其身必重。短气腹满而喘。有潮热者。此外欲解。可攻里也。手足 然而
汗出者。此大便已硬也。大承气汤主之。若汗多微发热恶寒者。外未解也。其热不潮。未可与承气汤。若
腹大满不通者。可与小承气汤微和胃气。勿令大泄下。
脉迟。阳明中寒之脉也。表邪未解。当恶寒而无汗。今虽汗出而不恶寒者。是邪气已入阳明之里。然终是脉迟。
为阴寒邪气。脾胃以膜相连。故有其身必重。短气腹满之太阴兼症也。邪实中焦。所以腹满身重。满则胃中填胀。
故短气而喘也。既汗出不恶寒而又潮热。乃外证欲解。邪已入胃。可以攻里之候也。然四肢皆禀气于胃。胃气实则
手足 然汗出。此为大便已硬。然后可以大承气汤主之。若其人汗多微发热而恶寒者。则又不然。汗多则知邪
气已在阳明。发微热恶寒。则又知太阳之表症未罢。故曰外未解也。凡邪实于胃。至申酉阳明气旺之时。必发潮热。
若其热不潮。则阳明里邪未实。大便犹未硬也。故未可与承气汤。然虽未可下。若腹大满不通者。不得已而欲下之。可
与小
承气汤。微和其胃气。勿令大泄下。何也。终以脉迟之故。胃中无大实热。所以不可大下也。
大承气汤方
大黄（四两酒洗） 浓朴（四两炙去皮） 枳实（五枚） 芒硝（三合）
上四味。以水一斗。先煮二物取五升。去滓。内大黄。煮取二升。去滓。内芒硝。更上火微一两沸。
分温再服。得下余勿服。
热邪归胃。邪气根据附于宿食粕滓而郁蒸煎迫。致胃中之津液枯竭。故发潮热而大便硬也。若不以大
承气汤下之。必致热邪败胃。谵语狂乱。循衣摸床等变而至不救。故必咸寒苦泄之药。逐使下出。则热邪随宿
垢而泄。犹釜底抽薪。薪去则火亦随薪而出矣。然非必宿垢满实而泄之也。胃中之热邪盛者。亦在所必
用。古人所谓用之以逐热邪。非下糟粕也。其制以苦寒下泄之大黄为君。咸寒软坚下走之芒硝为臣。又以辛温
下气之浓朴为佐。破气泄满之枳实为使。而后可以攻坚泻热也。若脉弱气馁。热邪不甚者。未可轻用也。
辨误 成氏谓承。顺也。邪气入胃。胃气郁滞。糟粕秘结。壅而为实。是正气不得舒顺也。以汤荡涤。
使塞者利而闭者通。正气得以舒顺。故曰承气也。愚谓此解犹未足以发仲景立方之义。谓之承气者。盖承其邪
盛气实。而以咸寒苦泄。荡涤攻下之也。但热实气盛者可用。无实热而正气虚馁者。不可攻也。若胃气已败。
正气将绝。虽力攻之。亦不得下矣。此无气可承之故也。即内经亢则害。承乃制之义。谓热邪亢害。而以咸寒苦
泄承制之。非舒顺其正气之谓也。观太阳阳明脾约之治。以无大实热。但胃中津液枯燥。故仅以小承气及麻仁丸
和润其胃燥。不令大泄下。则晓然
矣。
小承气汤方
大黄（四两，既名之曰小当是二两汉之二两即宋之五钱外分二次服耳） 浓朴（二两当是一两） 枳实（三枚）
以上三味。以水四升。煮取一升二合。分温二服。初服汤当更衣。不尔者尽饮之。若更衣者勿服之。
小承气者。即大承气而小其制也。大邪大热之实于胃者。以大承气汤下之。邪热轻者。及无大热。但胃中津
液干燥而大便难者。以小承气微利之。以和其胃气。胃和则止。非大攻大下之 剂也。以无大坚实。故于大承气
中去芒硝。又以邪气未大结满。故减浓朴枳实也。创法立方。惟量其缓急轻重而增损之。使无太过不及。适中病情
已耳。若不量虚实。不揆轻重。不及则不能祛除邪气。太过则大伤元气矣。临证审之。
阳明病。脉象迟缓。进食难以吃饱。若勉强吃饱，则会出现轻微心烦、头晕目眩的症状，并且必然导致小便困难。这是即将发生谷疸的征兆。即使使用泻下法治疗，腹部胀满的症状也不会减轻。之所以如此，是因为脉象迟缓（提示体内有寒）的缘故。
脉象迟缓，说明中焦有寒邪。进食难以吃饱，吃饱后出现轻微心烦，这是因为胃寒导致食物无法消化，强行吃饱会导致脘腹胀闷并引发心烦。头晕目眩，是因为谷物不能腐熟转化，浊气郁结蒸腾所致。
必然出现小便困难，是因为寒邪在里，下焦阳气不足（无火），气化功能无法正常进行。食物既不能消化，小便又排出不畅，导致水谷停滞壅塞，所以说是“欲作”谷疸。“欲作”的意思是，病情将要发作但尚未完全发作的时候。
所谓谷疸，是因为寒邪在中焦，胃不能腐熟，脾不能运化，导致谷物饮食停滞，引起中焦胀满和发黄。《通评虚实论》说：“黄疸突发疼痛，是由于五脏功能失调、六腑闭塞不通所产生的。”这里虽然使用了泻下法，但腹部胀满依旧如故，没有稍微减轻，这都是因为脉象迟缓且寒邪在里，所以用寒下法无效。
《阴阳应象大论》说：“寒气产生浊阴，热气产生清阳。”又说：“浊气停留在上部，就会产生胀满。”如果不温补中焦、散除寒邪，单纯使用泻下法是毫无益处的。
阳明病，如果是被寒邪所中而不能进食，小便不利，手足濈然汗出，这是即将形成“固瘕”的征兆，必定是大便开始干硬而后稀溏。之所以如此，是因为胃中寒冷，水谷不能分别的缘故。
这里的“若”字不必按照通常的字面意思解释。“若中寒不能食”，意思是如果阳明病被寒邪所中而不能进食，即前面所说的“不能食”属于中寒的含义。
小便不利，是因为寒邪在里，三焦的气化功能不行。濈然汗出，是邪气进入阳明的本证表现。但是手足濈然汗出，情况就不同了。
《阳明脉解篇》说：“四肢是诸阳之本。”《灵枢·终始篇》说：“阳气受气于四肢末端。”《太阴阳明论》说：“四肢都禀受胃气。”如下文所述，如果阳明病脉迟，伴有潮热且手足濈然汗出，那是大便已经变硬，这是胃气实盛而导致的濈然汗出。而这里所说的手足濈然汗出，是因为寒邪在胃，即将形成固瘕，导致四肢不能从胃中禀受气机，阳气不能通达四肢，卫气不固，所以手足也会冷汗淋漓地出汗。
寒邪固结，中焦之气运行不畅，所以想要形成固瘕。固瘕，是指寒气聚积在腹部导致坚硬，虽然不是石瘕或肠覃，但也类似于《月令》中所说的“水泽腹坚”的意思。大便初硬后溏，是因为在胃未受寒之时，中焦温暖，尚能保持坚实；自从中了寒邪之后，胃寒缺乏阳气的温化功能，三焦缺乏气化的作用，水谷不分，胃气不能保持坚实而导致大便稀溏。所以再次阐明其道理说：之所以如此，是因为胃中寒冷，水谷不能分别的缘故。
【辨误】注家们认为前人将坚固积聚解释为谬误，而说大便初硬后溏，因此形成瘕泄。瘕泄，就是溏泄。如果久而不止，就成为固瘕。我认为从“固瘕”二字推敲，可知它是坚凝固结的寒积，岂可以仅仅解释为溏泄久而不止呢？况且“初硬后溏”是“欲作固瘕”的征象，并不是说已经形成了固瘕，然后才出现初硬后溏。观察“欲作”二字，以及“必”字的含义，都是推测预判之词，不可以竟然当作既定事实来看待。
阳明病，起初想要进食，小便反而不利，大便正常。病人骨节疼痛，身体微微发热像是有热状，突然发狂，濈然汗出而病愈的，这是因为水液不足以胜邪，谷气与汗共同作用的结果，脉紧则表示病愈。
“初”，指阳明本经发病之初。“欲食”，并非指能大量进食。张仲景原话是说“能食”为中风，“不能食”为中寒。说“初欲食”，是指阳明受病之初，寒邪还在经络，尚未深入，胃气尚存，所以想要进食。胃中没有邪热，小便应当通利，现在小便不利，所以说“反”。寒邪固闭，三焦不运转，气化不行，所以小便反而不利。如果是阳明热邪归入里，大便应当硬结，现在反而正常，更知道没有里热。
骨节疼痛，是在经的寒邪未解除的表现。“翕翕如有热状”，是寒气衰退而阳气将要恢复的表现。“奄然发狂”，是郁伏的阳气迅速爆发，汗液想要排出而烦躁如狂的表现。身体微微发热，突然发狂，则是阳气回复、气机滋润，阳气蒸腾阴液而为汗，所以濈然汗出而寒邪得以解除。所谓“水不胜”，是指谷气与汗共同作用，其中含义不详。有人说：水，指津液；谷气，指胃气。水不胜，是指津液不足以化作汗源。脉紧则愈，是指在太阳病时，紧脉代表寒邪在表；在阳明病时，紧脉代表里气充实。脉浮代表邪气在经，紧脉则浮去而里气充实。推究其所以然的缘故，都是因为寒邪郁滞，没有阳气来蒸腾，津液就不能外达化为汗，所以说“水不胜”。胃阳的谷气，既然不能蒸腾津液化为汗，所以谷气与汗共同蕴结而不能发泄。《素问·评热论》说：“人之所以出汗，都是源于谷气，谷气生于精。现在邪气交争于骨肉之间而得到汗出的，是邪气退却而精气胜利的表现。精气胜利则应当能进食而不复发热。复发热的是邪气，汗出的是精气。”以此推断，人身之汗，都生于胃中的谷气。精，就是津液的称呼。“谷生于精”，是说津液乃由谷气所化生。谷气，就是胃中的阳气。阳气胜，就能蒸腾津液而为汗，所以是邪气退却而精气胜利。如果寒邪胜，阳气不能蒸腾津液而为汗，所以称为“水不胜”。（关于谷气的说法见太阳上编火劫第四条）
阳明病，不能进食，如果攻伐其热，必然会发生呃逆。之所以如此，是因为胃中虚冷的缘故。因为这个人本来体质虚弱，所以攻伐其热必然导致呃逆。
不能进食，是阳明中寒的表现。攻其热，就是用寒药来治疗它。哕，就是呃逆。之所以如此，大概是因为阳明中寒，胃中虚冷的缘故。因为这个人平素胃气本就属虚寒，而粗工见识浅薄，妄自认为是热证，而用寒下药物攻伐，导致苦寒伤胃，使胃阳败绝而成呃逆这种难治之证。
意思是胃中虚冷而不能进食的人，胃脘的阳气大衰，不仅是用寒药攻热会导致呃逆，即使是喝冷水，也会导致呃逆。
脉象浮而迟缓，表热里寒，下利清谷（拉出未消化的食物），用四逆汤主治。
这与少阴、厥阴病的里寒外热意义相同。如果是风邪致病，脉浮而表热，那么浮脉必定数急。现在虽然表热但脉迟缓，就知道阴寒在里，阴盛格拒阳气于外而表现为表热。虚阳在外，所以脉浮；阴寒在里，所以脉迟。所以下利清谷。这是真寒假热，所以用四逆汤祛除寒气，恢复真阳。如果以为是表邪而发汗，那就危险了。
阳明病，反而无汗而小便通利，过了两三天出现呕吐和咳嗽，手足厥冷的人，必定痛苦于头痛。如果不咳嗽、不呕吐，手足不厥冷，头就不痛。
阳明本经受病，本来应当自汗出，即使是刚从太阳转入阳明的，也应当濈然汗出。这里因为没有汗，所以说“反”。之所以无汗，是因为寒邪在阳明的经络。小便通利，说明里没有热邪。过了两三天出现呕吐和咳嗽，就知道无汗发生在两三天之前了。两三天前，就称为阳明病，尤其知道这是阳明本经自入的邪气，不是太阳传经而来的邪气。然而邪气由营卫而入，必须假道于太阳而入，所以无汗。一天无汗而小便通利，到了两三天出现呕吐、咳嗽、手足厥冷，这是寒邪入里。呕吐，是寒邪深入侵犯胃腑。咳嗽，是有声无痰的叫法，阴盛逼迫阳气于上，肺气上逆而咳嗽。四肢是诸阳之本，《太阴阳明论》说：“四肢都禀受胃气。”寒邪入胃，则阳气不能充盈于四肢，导致阴阳不相顺接而出现厥冷。呕吐、咳嗽而厥冷，则阴邪放纵，格拒阳气于上，所以虚火上浮而必定痛苦于头痛。如果不呕吐、不咳嗽、不厥冷，就没有阴盛格阳的病，所以头也不痛。
【辨误】这一条与阳明中风“但头眩不恶寒，故能食而咳，其人必咽痛；若不咳者咽不痛”的条文，一寒一热，恰好相对待，大概是向人们展示辨证的方法。奈何注家认为无汗、呕吐、咳嗽、手足厥冷，是得之于寒邪而邪热深重。不知道厥阴条内说“厥者必热，前热者后必厥”，因为厥阴是阴阳相半的经脉，所以有“厥深热亦深，厥微热亦微”的论述。所以又说如果反向发汗，必有口舌糜烂红肿的祸患。这一条虽然属于阳明，实际上是阳明中寒的证候，并没有热邪在里，岂能也这样论述？况且又说如果不咳嗽、不呕吐、不厥冷而小便通利，邪热必定顺着水道而出。我恐怕既有邪热在里，小便未必顺利，即使能通利，邪热也未必肯从小便而出。如果说邪气不从汗解，偏偏从水道而出，我不相信。成无己以伤寒寒邪内攻立论，方有执以寒胜为解，应当也相差无几。
阳明病，按法多汗，反而无汗，身体像虫子在皮肤中爬行一样的感觉，这是因为久病体虚的缘故。
邪气在阳明，按法应当多有自汗。现在反而无汗，而身体像虫子在皮肤中爬行一样，都是因为寒邪郁结在肌腠之间，不得发泄的缘故。这没有别的原因，不过是因元气素来虚弱，没有阳气来鼓动宣泄阴液以为汗，使得邪气想要外出而不能，所造成的。
进食就想呕吐的，属于阳明病，用吴茱萸汤主治。喝了药汤反而加重的，属于上焦病。
这是用来辨别太阳病和阳明病疑似症状的。进食就想呕吐，似乎像是阳明中寒的不能进食，所以说“属阳明”。胃寒不能纳受，所以用吴茱萸汤温胃。如果喝了药汤反而加重，就不是胃寒，仍然是太阳的表邪在胸膈而致呕吐，还没有进入胃腑，所以说是“属上焦”。娄氏认为喝了药汤反而加重，是火证，应当用生姜黄连治疗。他的意思是因为得热药反而加重，所以用苦寒药治疗，并加生姜止呕。不知道这仍然是太阳病的呕逆，尚属表邪。张仲景虽然没有立方，但如果发热无汗，尚未发表，外邪将次入胃而呕吐的，邪气仍在胸膈，应当用栀子豉汤涌吐，庶几近似。
吴茱萸汤方
吴茱萸（一升，洗净） 人参（三两） 生姜（六两） 大枣（十二枚）
以上四味药，用水七升，煮取二升，去渣滓，温服七合，每日三次服用。
吴茱萸一升，应当是一合，即现在的两勺半。人参三两，应当是一两，即宋代的二钱七分。生姜六两，应当是二两，即宋代的五钱余。大枣应当是四五枚。水七升，也应当是三升。看小承气汤只用水四升，调胃承气汤只用水三升，这个方子作为辛热补剂，用在表里疑似之间，难道反而过量了吗？大约出自后人之手，不是张仲景原本的升合分两。学人应当根据时代酌情使用。铢两升合法的换算见卷首。
阳明病，脉象迟缓，虽然出汗且不恶寒，身体必定沉重，短气、腹部胀满而喘息。如果有潮热的，这是表证将要解除，可以攻里的指征。手足濈然汗出的，这是大便已经变硬，用大承气汤主治。如果出汗多，伴有轻微发热和恶寒的，表证尚未解除，不能用承气汤。如果腹部显著胀满不通的，可以给予小承气汤轻微调和胃气，不要让它剧烈泻下。
脉象迟缓，是阳明中寒的脉象。表邪未解，应当恶寒而无汗。现在虽然出汗且不恶寒，是邪气已入阳明之里。但终究是脉迟，为阴寒邪气。脾胃通过膜相连，所以有身体沉重、短气、腹满等太阴兼症。邪气实于中焦，所以腹满身重。胀满则胃中填塞，所以短气而喘。既然出汗不恶寒又有潮热，乃是外证欲解，邪气已入胃，是可以攻里的候机。然而四肢都禀受胃气，胃气实则手足濈然汗出，这是大便已经变硬，然后才可以以大承气汤主治。如果其人出汗多，轻微发热而恶寒，则又不一样了。出汗多则知道邪气已在阳明，发轻微发热恶寒，则又知道太阳的表证未罢。所以说“外未解”。凡是邪气实于胃，到了申酉时（下午3-7点，阳明气旺之时），必定发潮热。如果热不呈潮热状，则阳明里邪未实，大便犹未硬，所以未可与承气汤。然而虽然不可峻下，如果腹部显著胀满不通，不得已想要下之，可以给小承气汤，轻微调和胃气，不要让它剧烈泻下。为什么呢？终究是因为脉迟的缘故，胃中没有大实热，所以不可大下。
大承气汤方
大黄（四两，酒洗） 浓朴（四两，炙，去皮） 枳实（五枚） 芒硝（三合）
以上四味药，用水一斗，先煮浓朴和枳实两味，取五升，去渣滓，加入大黄，煮取二升，去渣滓，加入芒硝，再上火微沸一两滚，分两次温服。如果大便通了，剩下的不要服。
热邪归入胃腑，邪气依附于宿食糟粕而郁蒸煎迫，导致胃中津液枯竭，所以发潮热而大便硬。如果不以大承气汤下之，必然导致热邪败坏胃气，出现谵语、狂乱、循衣摸床等变证而至不治。所以必须用咸寒苦泄的药物，迫使热邪随宿垢而下，犹如釜底抽薪，薪去则火亦随薪而出。然而并非一定要宿垢满实才泻下，胃中热邪盛的，也在所必用。古人所谓用此药是为了驱逐热邪，而非为了下糟粕。其制方以苦寒下泄的大黄为君药，咸寒软坚下走的芒硝为臣药，又以辛温下气的浓朴为佐药，破气泄满的枳实为使药，然后才可以攻坚泻热。如果脉弱气馁，热邪不甚者，不可轻用。
【辨误】成无己说：承，顺也。邪气入胃，胃气郁滞，糟粕秘结，壅塞而为实证，是正气不得舒顺。用汤药荡涤，使堵塞者通利，闭结者通畅，正气得以舒顺，所以叫承气。我认为这种解释还不足以阐发张仲景立方的深意。称之为承气，大概是顺应其邪盛气实的局面，而以咸寒苦泄之法，荡涤攻下之。只有热实气盛者可用，无实热而正气虚馁者，不可攻伐。如果胃气已败，正气将绝，虽然强力攻伐，也下不下来了。这就是“无气可承”的缘故。即《内经》“亢则害，承乃制”的意义，谓热邪亢害，而以咸寒苦泄承制之，并非舒顺其正气之意。看太阳阳明脾约的治疗，因为无大实热，只是胃中津液枯燥，所以仅用小承气及麻仁丸和润其胃燥，不令大泄下，这就很明白了。
小承气汤方
大黄（四两，既然名为小，应当是二两，汉代的二两即宋代的五钱，外分二次服耳） 浓朴（二两，应当是一两） 枳实（三枚）
以上三味药，用水四升，煮取一升二合，分两次温服。初次服药应当排便，如果不排便，就喝完所有的药。如果排便了，就不要服剩下的药。
小承气汤，就是大承气汤减小其剂量和力度。大邪大热实于胃者，用大承气汤下之。邪热轻者，及无大热，只是胃中津液干燥而大便难的，用小承气汤轻微通利，以调和胃气，胃气和则止，不是大攻大下的猛剂。因为没有大坚实，所以在大承气汤中去掉芒硝，又因为邪气未大结满，所以减少浓朴和枳实。创法立方，只是衡量病情的缓急轻重而增减，使无太过不及，适中病情而已。如果不衡量虚实，不揣度轻重，不及则不能祛除邪气，太过则大伤元气。临证时要审慎。
Yangming disease. The pulse is slow. It is difficult to eat until full. If one eats until full, slight irritability and dizziness will occur, and there will inevitably be difficulty in urination. This indicates that "Grain Jaundice" (Gu Dan, jaundice caused by food stagnation) is about to develop. Even if purgatives are used, abdominal fullness remains unchanged. The reason for this is the slow pulse (indicating internal cold).
A slow pulse indicates cold in the middle jiao. Difficulty eating until full, and slight irritability after eating, is due to stomach cold failing to transform food; forcing oneself to eat leads to distension and irritability. Dizziness occurs because grains fail to rot and transform, leading to the stagnation and steaming of turbid qi.
The inevitable difficulty in urination is due to cold pathogen in the interior, lack of fire in the lower jiao, and failure of qi transformation. Since food is not transformed and urination is difficult, water and grain become stagnant and obstructed, hence it is said that Grain Jaundice is "about to develop" (yu zuo), meaning at the time when it is about to manifest but has not yet fully developed.
Grain Jaundice refers to cold in the middle jiao where the stomach cannot transform and the spleen cannot transport, causing grain and food to stagnate, leading to middle jiao fullness and yellowing. The *Tong Ping Xu Shi Lun* states: "Sudden pain in jaundice arises from dysfunction of the five zang organs and obstruction of the six fu organs." Although purgatives are used here, abdominal fullness remains as before without any reduction. This is all because of the slow pulse and cold pathogen in the interior, rendering cold purgation ineffective.
The *Yin Yang Ying Xiang Lun* states: "Cold qi generates turbidity; heat qi generates clarity." It also states: "If turbid qi stays in the upper part, distension occurs." Without warming the middle and dispersing cold, purgation alone is of no benefit.
In Yangming disease, if one is struck by cold and cannot eat, with difficulty in urination and continuous sweating on the hands and feet, this indicates that "Gu Jia" (solid mass due to cold) is about to form. There will inevitably be stool that is initially hard and later loose. The reason is cold in the stomach, where water and grain are not separated.
The word "ruo" (if/whether) here should not be interpreted literally. "Ruo zhong han bu neng shi" means if Yangming disease is struck by cold pathogen and cannot eat, which aligns with the previous meaning that "cannot eat" signifies middle cold.
Difficulty in urination is due to cold pathogen in the interior and failure of qi transformation in the three jiao. Continuous sweating is a primary manifestation of pathogen entering Yangming. However, continuous sweating on the hands and feet is different.
The *Yangming Mai Jie* states: "The four limbs are the root of all yang meridians." The *Ling Shu · Zhong Shi Pian* states: "Yang receives qi at the extremities." The *Tai Yin Yang Ming Lun* states: "The four limbs all receive qi from the stomach." As mentioned below, if Yangming disease presents with a slow pulse, tidal fever, and continuous sweating on the hands and feet, it indicates that the stool has hardened; this is continuous sweating due to excess stomach qi. The continuous sweating mentioned here, however, is because cold pathogen is in the stomach, about to form Gu Jia, preventing the four limbs from receiving qi from the stomach. Yang qi fails to reach the four limbs, and defensive qi is insecure, causing cold sweat on the hands and feet.
Cold pathogen is firmly bound, and middle qi fails to circulate, hence Gu Jia is about to form. Gu Jia refers to cold accumulation making the abdomen hard. Although not Stone Fibroma or Intestinal Polyp, it resembles the meaning of "water and marshes freezing solid in the belly" described in the *Monthly Ordinances*. Stool that is initially hard and later loose occurs because before the stomach was struck by cold, the middle jiao was warm and capable of maintaining solidity. After being struck by cold, stomach cold lacks the function of yang transformation, and the three jiao lack qi transformation, so water and grain are not separated, and stomach qi fails to maintain solidity, resulting in loose stool. Thus, it reiterates: The reason is cold in the stomach, where water and grain are not separated.
[Correction of Misinterpretations] Commentators considered the previous interpretation of solid accumulation as erroneous, stating that initial hardness followed by looseness leads to "Jia Diarrhea" (Xia Xie), which is loose diarrhea. If prolonged, it becomes Gu Jia. I argue that inferring from the term "Gu Jia," it must refer to solidified cold accumulation. How can it be explained merely as prolonged loose diarrhea? Moreover, "initial hardness followed by looseness" is a sign of "Gu Jia about to form," not that Gu Jia has already formed and then presents with initial hardness followed by looseness. Observing the terms "about to form" and "inevitably," these are predictive words and should not be taken as established facts.
In Yangming disease, if initially desiring to eat, but urination is unexpectedly difficult, and stool is normal, and the person experiences joint pain, a mild feverish sensation, sudden madness, and continuous sweating leading to recovery, this is because fluids are insufficient to overcome the pathogen, and grain qi combines with sweat. A tight pulse indicates recovery.
"Chu" (initially) refers to the beginning of the disease in the Yangming proper meridian. "Yu shi" (desiring to eat) does not mean able to eat significantly. Zhang Zhongjing originally stated that "able to eat" indicates Wind Strike, while "unable to eat" indicates Cold Strike. Saying "initially desiring to eat" means at the beginning of Yangming disease, the cold pathogen is in the meridian and has not deeply penetrated; stomach qi still exists, hence the desire to eat. With no pathogenic heat in the stomach, urination should be unobstructed. Now, since urination is difficult, it is called "unexpectedly." Cold pathogen is firmly closed, the three jiao do not circulate, and qi transformation fails, hence urination is unexpectedly difficult. If Yangming heat pathogen entered the interior, stool would likely be hard. Now that it is normal, it confirms the absence of interior heat.
Joint pain indicates that the cold pathogen in the meridian has not resolved. A mild feverish sensation indicates that cold qi is receding and yang qi is recovering. Sudden madness indicates that suppressed yang qi suddenly erupts, and sweat desires to exit, causing irritability resembling madness. Mild fever and sudden madness indicate yang recovery and qi moistening. Yang steams yin to produce sweat, hence continuous sweating allows the cold pathogen to resolve. "Water is insufficient" refers to grain qi combining with sweat; its precise meaning is unclear. Some say: Water refers to body fluids; grain qi refers to stomach qi. "Water is insufficient" means body fluids are inadequate to generate sweat. A tight pulse indicates recovery: in Taiyang disease, a tight pulse means cold pathogen in the exterior; in Yangming disease, it means interior qi is substantial. A floating pulse means pathogen in the meridian; a tight pulse means the floating quality disappears and interior qi becomes substantial. Investigating the reason, it is because cold pathogen is stagnant, lacking yang qi to steam and ascend, so body fluids cannot reach the exterior to become sweat. Hence, "water is insufficient." Stomach yang's grain qi, unable to steam body fluids into sweat, causes grain qi and sweat to combine and fail to dissipate. The *Su Wen · Ping Re Lun* states: "Human sweating originates from grain qi, and grain qi is generated from essence. Now, when pathogen contends between flesh and bones and sweat is produced, it means pathogen retreats and essence prevails. When essence prevails, one should be able to eat and not have recurrent fever. Recurrent fever is pathogen; sweat is essence." Inferring from this, human sweat is generated from grain qi in the stomach. Essence refers to body fluids. "Grain qi generates essence" means body fluids are transformed from grain qi. Grain qi is the yang qi in the stomach. When yang qi prevails, it steams body fluids into sweat, thus representing pathogen retreat and essence victory. If cold pathogen prevails, yang qi cannot steam body fluids into sweat, hence it is called "water is insufficient." (See discussion on grain qi in Taiyang Upper Volume, Fire Coercion Item 4).
In Yangming disease, inability to eat, if one attacks the heat,必将 result in hiccups. The reason is deficiency-cold in the stomach. Because the person is fundamentally deficient, attacking the heat will inevitably cause hiccups.
Inability to eat indicates Yangming middle cold. Attacking the heat means treating it with cold herbs. Hiccups (yue) refer to hiccuping. The reason is Yangming middle cold and deficiency-cold in the stomach. Because the person's stomach qi is inherently deficient and cold, ignorant physicians mistakenly diagnose heat and use cold purgatives, damaging stomach yang with bitter-cold herbs, causing stomach yang to collapse and resulting in refractory hiccups.
If deficiency-cold in the stomach prevents eating, drinking water will cause hiccups.
This means that for those with deficiency-cold in the stomach unable to eat, the yang qi of the stomach chamber is severely depleted. Not only will attacking heat with cold herbs cause hiccups, but even drinking cold water will induce them.
Pulse is floating and slow, exterior heat and interior cold, with diarrhea of undigested food. Treat with Si Ni Tang (Four Counterflow Decoction).
This shares the same principle as Shaoyin and Jueyin diseases presenting with interior cold and exterior heat. If wind pulse were floating with exterior heat, the floating pulse would be rapid. Now, although there is exterior heat, the pulse is slow, indicating interior yin-cold. Yin excess repels yang to the exterior, causing exterior heat. Deficient yang is outside, hence the pulse floats; yin-cold is inside, hence the pulse is slow. Thus, diarrhea of undigested food occurs. This is true cold with false heat, so Si Ni Tang is used to dispel cold and restore true yang. If mistaken for exterior pathogen and treated with sweating, it would be dangerous.
In Yangming disease, unexpectedly no sweat, but clear urination. After two or three days, vomiting and coughing occur, with cold hands and feet. Such a person will surely suffer from headache. If there is no cough, no vomiting, and no cold hands and feet, the head will not hurt.
When the Yangming proper meridian is diseased, spontaneous sweating should naturally occur. Even if transferring from Taiyang to Yangming, continuous sweating should occur. Here, because there is no sweat, it is called "unexpectedly." The reason for no sweat is cold pathogen in the Yangming meridian. Clear urination indicates no heat pathogen in the interior. Vomiting and coughing after two or three days indicate that the lack of sweat occurred before two or three days ago. Referring to it as Yangming disease two or three days prior confirms that this is pathogen entering directly from the Yangming proper meridian, not transmitted from Taiyang. However, pathogen enters via Ying and Wei, passing through Taiyang first, hence no sweat. One day of no sweat and clear urination, progressing to two or three days of vomiting, coughing, and cold hands and feet, indicates cold pathogen entering the interior. Vomiting indicates cold pathogen deeply invading the stomach. Coughing, defined as sound without phlegm, occurs because yin excess forces yang upward, causing lung qi to rebel and cough. The four limbs are the root of all yang. The *Tai Yin Yang Ming Lun* states: "The four limbs all receive qi from the stomach." Cold pathogen entering the stomach prevents yang qi from filling the four limbs, causing yin and yang to fail to connect smoothly, resulting in cold limbs. Vomiting, coughing, and cold limbs indicate yin pathogen running rampant, repelling yang upward, causing deficient fire to float up and resulting in severe headache. If there is no vomiting, coughing, or cold limbs, there is no yin excess repelling yang, hence no headache.
[Correction of Misinterpretations] This clause contrasts with the Yangming Wind Strike clause: "Only dizziness, no aversion to cold, hence able to eat and cough, person will surely have sore throat; if no cough, no sore throat." One is cold, one is heat, exactly opposing each other, demonstrating differentiation methods. Why do commentators think that no sweat, vomiting, coughing, and cold limbs result from cold pathogen causing deep heat? They ignore the Jueyin clause stating "cold limbs must involve heat, prior heat leads to subsequent cold limbs," because Jueyin is a half-yin half-yang meridian, hence the theory "deeper cold limbs mean deeper heat, milder cold limbs mean milder heat." Thus, they add that reversing sweating will cause mouth ulcers. Although this clause belongs to Yangming, it is actually Yangming middle cold, with no heat pathogen in the interior. How can it be interpreted this way? Furthermore, they state that if no cough, vomiting, or cold limbs, but clear urination, heat pathogen must exit via the water pathway. I fear that if there were heat pathogen in the interior, urination might not be smooth. Even if smooth, heat pathogen might not willingly exit via urine. To say pathogen exits via water instead of sweat, I do not believe it. Cheng Wuji based his theory on cold pathogen attacking internally; Fang Youzhi explained it as cold prevailing. Their views are likely not far apart.
In Yangming disease, according to method, there should be much sweat. Unexpectedly no sweat, and the body feels like insects crawling in the skin. This is due to long-standing deficiency.
Pathogen in Yangming should naturally have much sweating. Now unexpectedly no sweat, and the body feels like insects crawling, all due to cold pathogen stagnating between muscle and cutaneous layers, unable to dissipate. This is simply because primordial qi is inherently deficient, lacking yang qi to鼓动 (stimulate) and release yin fluids as sweat, causing pathogen to desire exit but fail to do so.
Desire to vomit after eating grain belongs to Yangming disease. Treat with Wu Zhu Yu Tang (Evodia Decoction). If symptoms worsen after taking the decoction, it belongs to the upper jiao.
This distinguishes between suspected Taiyang and Yangming diseases. Desire to vomit after eating seems like Yangming middle cold inability to eat, hence "belongs to Yangming." Stomach cold fails to accept, so Wu Zhu Yu Tang warms the stomach. If worsening after taking the decoction, it is not stomach cold, but rather Taiyang exterior pathogen in the chest causing vomiting, not yet entering the stomach, hence "belongs to upper jiao." Lou believed that worsening after taking the decoction indicates fire, suggesting Ginger and Coptis treatment. His reasoning was that worsening with heat implies using bitter-cold herbs plus ginger for vomiting. He did not realize this is still Taiyang vomiting due to exterior pathogen. Although Zhang Zhongjing did not prescribe a formula, if fever and no sweat exist, exterior has not been released, and exterior pathogen is about to enter the stomach causing vomiting, the pathogen is still in the chest. Zhi Zi Chi Tang (Gardenia and Fermented Soybean Decoction) should be used to induce vomiting, which would be approximately correct.
Wu Zhu Yu Tang Formula
Wu Zhu Yu (Evodiae Fructus, 1 sheng, washed) Renshen (Ginseng Radix et Rhizoma, 3 liang) Shengjiang (Zingiberis Rhizoma Recens, 6 liang) Dazao (Jujubae Fructus, 12 pieces)
These four ingredients, with 7 sheng of water, boil to obtain 2 sheng, remove dregs, take 7 ge warm, three times daily.
One sheng of Wu Zhu Yu should be one he, i.e., two and a half spoons today. Three liang of Renshen should be one liang, i.e., 2.7 qian in Song dynasty. Six liang of Shengjiang should be two liang, i.e., over 5 qian in Song dynasty. Dates should be 4-5 pieces. Seven sheng of water should be three sheng. Looking at Xiao Cheng Qi Tang using only 4 sheng of water, and Tiao Wei Cheng Qi Tang using only 3 sheng, this formula, being a pungent-warm tonic used between exterior-interior suspicions, could it be excessive? It likely originated from later hands, not Zhang Zhongjing's original measurements. Scholars should adjust dosages according to times. See volume preface for conversion.
Yangming disease, pulse slow, although sweating and no aversion to cold, the body will surely feel heavy, short of breath, abdominal fullness, and wheezing. If there is tidal fever, the exterior is about to resolve, and interior can be attacked. Continuous sweating on hands and feet indicates stool has hardened. Treat with Da Cheng Qi Tang (Major Order the Qi Decoction). If sweating is profuse with slight fever and aversion to cold, exterior has not resolved. If fever is not tidal, do not give Cheng Qi Tang. If abdominal distension is severe and unblocked, Xiao Cheng Qi Tang (Minor Order the Qi Decoction) may be given to mildly harmonize stomach qi, avoiding drastic purgation.
Slow pulse is the pulse of Yangming middle cold. Exterior pathogen unresolved should present with aversion to cold and no sweat. Now, although sweating and no aversion to cold, pathogen has entered Yangming interior. But ultimately the pulse is slow, indicating yin-cold pathogen. Spleen and stomach are connected by membranes, hence there are Taiyin concomitant symptoms like heavy body, shortness of breath, and abdominal fullness. Pathogen excess in middle jiao causes abdominal fullness and heaviness. Fullness fills the stomach, causing shortness of breath and wheezing. Having sweated, no aversion to cold, and tidal fever indicates exterior resolving and pathogen entering stomach, ready for interior attack. However, four limbs receive qi from stomach. When stomach qi is excess, hands and feet sweat continuously, indicating stool has hardened. Only then can Da Cheng Qi Tang be used. If the person sweats profusely with slight fever and aversion to cold, it is different. Profuse sweating indicates pathogen in Yangming; slight fever and aversion to cold indicate Taiyang exterior syndrome has not ceased. Hence "exterior not resolved." Whenever pathogen excess in stomach, during Shen-You hours (3-7 PM, peak Yangming qi), tidal fever must occur. If fever is not tidal, Yangming interior pathogen is not excess, and stool is not hardened. Hence Cheng Qi Tang cannot be given. Although drastic purgation is not indicated, if abdominal distension is severe and unblocked, out of necessity, Xiao Cheng Qi Tang may be given to mildly harmonize stomach qi, avoiding drastic purgation. Why? Ultimately due to the slow pulse, there is no major excess-heat in the stomach, so drastic purgation is contraindicated.
Da Cheng Qi Tang Formula
Dahuang (Rhei Radix et Rhizoma, 4 liang, wine-washed) Nongpo (Magnoliae Officinalis Cortex, 4 liang, roasted, peeled) Zhishi (Aurantii Fructus Immaturus, 5 pieces) Mangxiao (Natrii Sulfas, 3 he)
These four ingredients, with 1 dou of water, first boil Nongpo and Zhishi to obtain 5 sheng, remove dregs, add Dahuang, boil to obtain 2 sheng, remove dregs, add Mangxiao, heat slightly for one or two boils. Divide into two warm doses. If bowel movement occurs, do not consume the remainder.
Heat pathogen entering the stomach attaches to retained food and fecal matter, steaming and pressing, depleting stomach fluids, causing tidal fever and hardened stool. If not purged with Da Cheng Qi Tang, heat pathogen will damage stomach qi, leading to delirium, mania, grasping at bedclothes, etc., unto death. Hence, salty-cold and bitter-purgative drugs are necessary to force expulsion. Heat pathogen exits with old filth, like removing firewood from under the cauldron; when wood is gone, fire goes with it. However, it is not only for full retention of filth; if stomach heat pathogen is abundant, it is also necessary. Ancients said this drug is used to purge heat pathogen, not just feces. The formulation uses bitter-cold purgative Dahuang as Sovereign, salty-cold softening Mangxiao as Minister, pungent-warm qi-descending Nongpo as Assistant, and qi-breaking fullness-relieving Zhishi as Envoy, thereby enabling hard-drilling and heat-clearing. If pulse is weak and qi deficient, with mild heat, it should not be used lightly.
[Correction of Misinterpretations] Cheng Wuji said: Cheng means to obey/smooth. Pathogen enters stomach, stomach qi stagnates, feces bind, becoming excess, preventing righteous qi from smoothing. The decoction cleanses, making blocked passages smooth and closed ones open, allowing righteous qi to smooth, hence "Cheng Qi." I believe this explanation is insufficient to reveal Zhang Zhongjing's intent. Calling it "Cheng Qi" likely means accommodating the excess pathogen and substantial qi, using salty-cold and bitter-purgative methods to cleanse and purge. It is usable only for heat-excess and qi-substantial cases; for non-excess-heat and righteous qi-deficient cases, purgation is contraindicated. If stomach qi has failed and righteous qi is about to perish, even strong purgation will not work. This is the case of "no qi to accommodate." It aligns with the *Nei Jing* principle "Excess causes harm, accommodation brings control," meaning heat pathogen excess is controlled by salty-cold and bitter-purgatives, not merely smoothing righteous qi. Observing the treatment of Taiyang-Yangming Spleen Constraint, due to lack of major excess-heat and only dry stomach fluids, only Xiao Cheng Qi Tang and Ma Ren Wan are used to moisten stomach dryness, avoiding drastic purgation, which clarifies this point.
Xiao Cheng Qi Tang Formula
Dahuang (Rhei Radix et Rhizoma, 4 liang, though named "Small," should be 2 liang; Han 2 liang equals Song 5 qian, divided into two doses) Nongpo (Magnoliae Officinalis Cortex, 2 liang, should be 1 liang) Zhishi (Aurantii Fructus Immaturus, 3 pieces)
These three ingredients, with 4 sheng of water, boil to obtain 1 sheng 2 he, divide into two warm doses. First dose should result in bowel movement. If not, drink the rest. If bowel movement occurs, do not take the rest.
Xiao Cheng Qi Tang is Da Cheng Qi Tang with reduced dosage and strength. For major pathogen and major heat excess in stomach, Da Cheng Qi Tang is used. For mild heat pathogen, or no major heat, only dry stomach fluids and difficult stool, Xiao Cheng Qi Tang mildly promotes bowel movement to harmonize stomach qi. Stop when stomach harmonizes; it is not a drastic purgative. Because there is no major hardness, Mangxiao is removed from Da Cheng Qi Tang. Because pathogen is not greatly knotted and full, Nongpo and Zhishi are reduced. Creating methods and formulas involves adjusting based on urgency and severity, avoiding excess or deficiency, fitting the condition. If one does not assess deficiency/excess or weigh severity, insufficiency fails to expel pathogen, while excess severely damages primordial qi. Exercise caution in clinical practice.